Diagnosing Hodgkin Lymphoma in Adults

Hodgkin lymphoma is a cancer of the lymph system, a major component of the body’s immune system, which includes blood cells, tissues, and organs. The blood cells include white blood cells, which fight infection; red blood cells, which carry oxygen; and platelets, which help blood clot.

In Hodgkin lymphoma, cancerous white blood cells spread to lymph nodes and to organs, such as the spleen and lungs. If the cells continue to divide uncontrollably, they form a growth, or tumor.

Named after the doctor who first identified it, Hodgkin lymphoma is most common in people aged 15 to 30 and those older than 55. Because the condition affects teenagers and young adults, doctors often work with pediatric oncologists at the Stephen D. Hassenfeld Children’s Center for Cancer and Blood Disorders to manage Hodgkin lymphoma in children.

There is no known cause, but some people with Hodgkin lymphoma test positive for the Epstein-Barr virus, which causes mononucleosis. Other risk factors include infection with human immunodeficiency virus (HIV), which can lead to AIDS, and a family history of Hodgkin lymphoma.

In most instances, Hodgkin lymphoma is curable, even in people with advanced cancer.

Symptoms include painless, swollen lymph nodes, mainly in the neck, armpit or groin; chronic abdominal pain; unexplained fever; coughing; itching; night sweats; persistent fatigue; and unexplained weight loss. Some people may experience an increased sensitivity to alcohol—which may include discomfort in the lymph nodes—though doctors don’t know why.

Diagnostic Tests

To diagnose Hodgkin lymphoma, NYU Langone’s hematologist–oncologists—blood cancer specialists—take a medical history, conduct a physical exam, and order a variety of tests. NYU Langone pathologists—doctors who examine blood or tissue under a microscope—perform further tests to pinpoint the diagnosis. These tests help your doctor identify which areas of the body are affected and can help determine treatment.

Blood Test

A specialist draws blood to check for the number and type of white blood cells circulating in it. This can help distinguish lymphoma from leukemia, in which cancer cells crowd out healthy ones in the bone marrow, the spongy tissue inside bones. He or she may also look for tumor markers, such as proteins and enzymes, that are associated with Hodgkin lymphoma.

The doctor may assess your overall health by identifying the number of red blood cells, which carry oxygen throughout the body; and platelets, which help blood clot.

PET/CT Scan

PET and CT scans may be used to locate tumors and determine how advanced the cancer is. Your doctor may also order these tests during and after treatment to assess its effectiveness.

In a PET/CT scan, two imaging tests provide information about tissues and organs. A CT scan produces three-dimensional, cross-sectional images of tissues and organs using a series of X-rays. Prior to the scan, you may be given a contrast agent, or dye, that highlights the organs.

A PET scan involves injecting a small amount of a radioactive sugar into a vein, which collects in cancer cells. Because cancer cells process sugars more quickly than healthy cells do, cancer appears brighter on PET scans.

Together, these tests can help your doctor distinguish between cancerous and noncancerous tissue and slow- and fast-growing tumors. A PET/CT scan provides a more complete picture of what is happening in the body than either test can provide on its own. The scans are performed one after the other using the same machine and take about 45 minutes total to complete.

Excisional or Incisional Lymph Node Biopsy

A lymph node biopsy helps doctors determine the type of lymphoma a person has. Hodgkin lymphoma can be identified by what are known as Reed-Sternberg cells, which are found only in Hodgkin lymphoma.

In an excisional biopsy, which requires local anesthesia, an enlarged lymph node is surgically removed. In an incisional biopsy, part of a larger tumor or lymph node is surgically removed. General anesthesia is used. A sample of these cells is then examined under a microscope.

Your doctor uses stitches to close the incision. A biopsy typically takes about 30 minutes.

Core Needle Biopsy

Surgeons may perform a core needle biopsy if a tumor or the lymph nodes are located in difficult-to-reach areas, such as the lungs or spleen.

In a core needle biopsy, your doctor gives you a local anesthetic, then inserts a needle into the skin to remove a sample of tissue.

A pathologist examines the tissue under a microscope. Sometimes, a CT scan is used to guide the doctor during the procedure.

Bone Marrow Aspiration and Biopsy

This procedure can help doctors determine if Hodgkin lymphoma has spread to the bone marrow, indicating the cancer is advanced. In a bone marrow aspiration, a doctor gives you a local anesthetic to numb the skin and pelvic bone. Next, he or she inserts a thin needle into the pelvic bone to remove a sample of bone marrow fluid. Cells from the fluid are analyzed under a microscope.

This procedure provides a larger sample of tissue than other types of biopsy, allowing the pathologists to determine if the cancer is advanced and more aggressive treatment may be needed.